Job Summary

BASIC FUNCTION
Understand components of pharmacy pricing being able to articulate competitive differences of HCSC and competitor proposals to internal and external audiences. Confidently model and forecast Pharmacy analyses in a clear and concise manner and present to Management on a frequent basis. Act as Underwriting Pharmacy Subject Matter Expert supporting department in leading completion of RX quotes and RFPs. Ensure the retention and profitability of existing business through the calculation of appropriate renewal pricing. Utilize all currently available information, models, and knowledge to accurately predict future claims and non-claims expenses for Renewals and RFPs. Works closely with Management to provide alternate benefit plans, risk and/or funding arrangements. Be responsible for contracting on case work and update internal databases, etc. Coordinate with Proposal Unit to ensure accurate and timely RFP completion. Enforce adherence to Underwriting Guidelines and be responsible for approval of exceptions. Identify areas for potential process improvements and work with management to help in their development and implementation. Participate in project work with other departments. Maintain consistent high level of service to our sales representatives and clients with respect to renewal and proposal timeliness and accuracy. Monitor PBM and pharmacy market trends, competitor pricing, and regulatory changes to inform underwriting strategy.

NOTE: relocation is NOT offered; sponsorship is NOT available either now or in the future.

Required Job Qualifications

• Bachelor's degree OR three (3) years of experience in a group health insurance function.
• Three (3) years of experience underwriting cases of lessor complexity OR Demonstrated capability to meet required job responsibility.
• Successfully demonstrated skills and experience in underwriting and pricing of various funding options and products and making sound decisions.
• Math skills including the four basic math calculations (addition, subtraction, division & multiplication) and ability to estimate for mathematical reasonableness.
• Successfully demonstrated interpersonal skills establishing and maintaining business relationships.
• Independent judgment and problem resolution skills.
• Work management skills including the ability to multi-task, prioritize, and manage time and workload to meet deadlines.
• Verbal and written communication skills to include correct grammar, word choice, precision, conciseness, structure, audience appropriate tone and language.
• PC proficiency to include Word and Excel.
• Successfully Demonstrated skills and experience in presenting to external clients.
• Extensive knowledge and skill applying state and federal legislation governing underwriting practices.
• Effective Negotiation skills.
• Successfully demonstrated skills for performing risk qualification.
• Financial analysis and underwriting skills.
• Successful experience achieving positive results dealing with customers, consultants and brokers.
• Skills to deliver on the job training.
• Extensive experience-based knowledge of group medical products, discount practices, stop loss and performance guarantees.

Preferred Job Qualifications

• For Large Group: Demonstrated experience to underwrite experience rated and manually rated health insurance products with sound underwriting judgment.
• Knowledge of the Blue System and ability to price National business.
• Rotation through multiple UW market segments.

~ KEY FUNCTIONS ~

• Responsible for the management and maintenance of the following operational aspects of network programs:
• Project / Enhancements / Initiative planning and implementation
• Cross functional departmental coordination
• Program management and administration including data maintenance / processing, identifying providers for recruitment or education, research and resolution of issues, answering inquiries
• Communications / Training including network management representative training, provider correspondence, webinars and related presentation material development
• Results reporting and analysis coordination
• System Testing
• Coordinate with HCSC plans in support of network programs.
• Perform operational functions for specified network programs and serve as plan lead. Coordinate with internal resources for implementation and operation tasks.
• Establish relationships with appropriate HCSC representatives including technical areas, and coordinate operational activities with HCSC plans to promote synergies and consistency within HCSC.
• Participate in BCA and/or external entities meetings when appropriate.
• Identify and implement continuous improvement opportunities.

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting .

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Base Pay Range
$61,500.00 - $136,100.00

Exact compensation may vary based on skills, experience, and location.